Urogynecology, also known as female pelvic medicine and reconstructive surgery (FPMRS), is a subspecialty for OB/GYNs focused on non-malignant pelvic floor dysfunctions, such as urinary incontinence. While it’s usually clear when to refer your patients to an OB/GYN or a urologist, urogynecology is an often-misunderstood subspecialty when it comes to patient referrals.Read More
Endometriosis—which impacts nearly 6.5 million people in the United States—occurs when endometrial tissue grows outside of the uterus. When these extraneous growths, known as lesions, are left untreated, they can flare up and cause pain when menstruating, during sexual activity or during a bowel movement or urination. Growths are often followed by abnormal bleeding that can build up and lead to severe uterine scarring.
Although common, this condition is frequently underdiagnosed or undiagnosed because its symptoms are categorized as normal uterine pain. “Some of the biggest misconceptions are that endometriosis pain is in the patient’s head, that they are overestimating their pain or that patients with endometriosis cannot get pregnant—and that’s not true,” said Samantha DeLuca, D.O., an OB/GYN at Inspira Medical Group Obstetrics and Gynecology.
Understanding the Endometriosis Symptom and Treatment Spectrum
Treating endometriosis requires a unique plan for each patient. Studies show that it can take six to 10 years from the first complaint of symptoms to receive a proper endometriosis diagnosis. While fast diagnosis decreases the risk of uterine issues, treating endometriosis starts with correctly identifying symptoms, which can be difficult.
“Symptoms vary widely among patients with endometriosis, but most commonly they include painful periods, painful sex and chronic pelvic pain. People with the worst endometriosis pain may have hardly any visible endometriosis at surgery, while people with no pain can have significant visible disease,” said Dr. DeLuca. “Making this sometimes-difficult diagnosis is the first step toward proactive care. We have numerous treatment options that not only give patients relief but help restore their quality of life.”
When treating endometriosis, the first step is to eliminate other causes of pelvic pain, such as sexually transmitted infections, pelvic inflammatory disease, irritable bowel syndrome or interstitial cystitis. “Initial treatment is aimed at minimizing menstrual bleeding and pain through a combination of birth control pills and nonsteroidal anti-inflammatory drugs (NSAIDs),” said Dr. DeLuca. “Really, any hormonal birth control that lightens or stops menstrual flow is useful for treating endometriosis.”
More aggressive treatment for refractory symptoms involves estrogen receptor modulators and minimally invasive surgery such as laparoscopic cautery or excision of lesions.
Busting Endometriosis and Uterine Myths
For Dr. DeLuca, the most important thing about endometriosis care is that providers take patients with pelvic pain seriously. Specifically, Dr. DeLuca says that uterine pain should be investigated.
“We need to move away from normalizing uterine pain. Periods shouldn’t be debilitating or cause lost time from work or school—it is not natural to have severe pelvic pain,” said Dr. DeLuca. “The best thing we can do as providers is to take complaints seriously. We need to pay attention to the hallmark signs: painful periods, painful sex, chronic pelvic pain, GI symptoms and painful bowel movements or urination. These are signs that a patient should be referred immediately.”
In addition to challenging the normalization of uterine pain, Dr. DeLuca also clarifies that endometriosis can and does cause infertility. Forty percent of people with infertility have endometriosis. Closely tracking symptoms and understanding family history can lead patients to more immediate relief and fertility preservation.
“I have a patient whose mother suffered from endometriosis and had serious issues with infertility. Now, my patient is presenting similar symptoms. Because we knew her family history, my index of suspicion for endometriosis was high. Now, we have offered her normal menstrual cycle suppression which is working well to relieve her symptoms and hopefully, preserve her fertility,” said Dr. DeLuca.
For Dr. DeLuca, the most important thing about endometriosis care is that providers take patients with pelvic pain seriously. To learn more, or to refer a patient to Dr. DeLuca, contact her office directly at (856) 845-4061.